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. 2024 Apr 4;6(1):19.
doi: 10.1186/s42466-024-00314-7.

Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review

Johanna K Rickel  1   2 , Daria Zeeb  3   4   5 , Susanne Knake  2   3 , Hans Urban  6   5 , Jürgen Konczalla  7   5 , Katharina J Weber  8   9   10   5 , Pia S Zeiner  6   8   9   5 , Axel Pagenstecher  11   5 , Elke Hattingen  12   5 , André Kemmling  13   5 , Emmanouil Fokas  8   14   5 , Sebastian Adeberg  15   16   5 , Robert Wolff  17   5 , Martin Sebastian  18   5 , Tillmann Rusch  19   5 , Michael W Ronellenfitsch  6   8   9   5 , Katja Menzler  3 , Lena Habermehl  3 , Leona Möller  3 , Marcus Czabanka  7   5 , Christopher Nimsky  4   5 , Lars Timmermann  3 , Christian Grefkes  1 , Joachim P Steinbach  6   8   9   5 , Felix Rosenow  1   2 , Leena Kämppi #  1   20 , Adam Strzelczyk #  21   22   23
Affiliations

Status epilepticus in patients with brain tumors and metastases: A multicenter cohort study of 208 patients and literature review

Johanna K Rickel et al. Neurol Res Pract. .

Abstract

Objective: Brain tumors and metastases account for approximately 10% of all status epilepticus (SE) cases. This study described the clinical characteristics, treatment, and short- and long-term outcomes of this population.

Methods: This retrospective, multi-center cohort study analyzed all brain tumor patients treated for SE at the university hospitals of Frankfurt and Marburg between 2011 and 2017.

Results: The 208 patients (mean 61.5 ± 14.7 years of age; 51% male) presented with adult-type diffuse gliomas (55.8%), metastatic entities (25.5%), intracranial extradural tumors (14.4%), or other tumors (4.3%). The radiological criteria for tumor progression were evidenced in 128 (61.5%) patients, while 57 (27.4%) were newly diagnosed with tumor at admission and 113 (54.3%) had refractory SE. The mean hospital length of stay (LOS) was 14.8 days (median 12.0, range 1-57), 171 (82.2%) patients required intensive care (mean LOS 8.9 days, median 5, range 1-46), and 44 (21.2%) were administered mechanical ventilation. All patients exhibited significant functional status decline (modified Rankin Scale) post-SE at discharge (p < 0.001). Mortality at discharge was 17.3% (n = 36), with the greatest occurring in patients with metastatic disease (26.4%, p = 0.031) and those that met the radiological criteria for tumor progression (25%, p < 0.001). Long-term mortality at one year (65.9%) was highest in those diagnosed with adult-type diffuse gliomas (68.1%) and metastatic disease (79.2%). Refractory status epilepticus cases showed lower survival rates than non-refractory SE patients (log-rank p = 0.02) and those with signs of tumor progression (log-rank p = 0.001).

Conclusions: SE occurrence contributed to a decline in functional status in all cases, regardless of tumor type, tumor progression status, and SE refractoriness, while long-term mortality was increased in those with malignant tumor entities, tumor progressions, and refractory SE. SE prevention may preserve functional status and improve survival in individuals with brain tumors.

Keywords: Astrocytoma; Epilepsy; Glioblastoma; Meningioma; Seizure.

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Conflict of interest statement

S. Knake has received support from Angelini Pharma, Bial, Desitin Arzneimittel, Eisai, Epilog, Jazz (GW) Pharmaceuticals, Merck Serono and UCB (Zogenix) Pharma in the form of speaker honoraria; M.W. Ronellenfitsch has received support in the form of a research grant from UCB and an honorarium for advisory board participation from Alexion; L. Habermehl has received support from Jazz Pharma, Zogenix, and Angelini pharma in the form of reimbursed travelling expenses and training costs; S. Adeberg has received support from, Accuray Inc., AstraZeneca GmbH, Bristol Myers Squibb GmbH & Co., MSD, Novocure GmbH, Merck KGaA, and Fakultät Heidelberg in the form of honoraria /travel reimbursements; research cooperations with Novocure GmbH, and scientific advisory compensation from Accuray Inc., Sanofi Genzyme, Novartis, and Novocure GmbH; M. Sebastian has received support in the form of an institutional grant from AstraZeneca of the United Kingdom, travel grants from Takeda and Pfizer of Germany, and consulting fees and honoraria for lectures from AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Novartis, Lilly, Roche, Boehringer Ingelheim, Amgen, Takeda, Johnson, Merck-Serono, GlaxoSmithKline, and Daiichi; Ch. Nimsky has received support as a scientific consultant for Brainlab and speaker honoraria from B. Braun, BK medical, and Brainlab. L. Timmermann has received support in the form of occasional consultation payments from Boston Scientific and speaker’s honoraria for symposia sponsored by Boston Scientific, AbbVIE, Novartis, Neuraxpharm, Teva, the Movement Disorders Society, and DIAPLAN. The institution of L.T., and not L.T. personally, received funding from Boston Scientific, the German Research Foundation, the German Ministry of Education and Research, the Otto-Loewi-Foundation, and the Deutsche Parkinson Vereinigung. Neither L.T. nor any member of his family holds stocks, stock options, patents, or financial interests in any of the above-mentioned companies or their competitors. L. Timmermann serves as the president of the German Neurological Society without payment or income. C. Grefkes reports that he is part of the editorial board of Neurological Research and Practice. J.P. Steinbach has received support in the form of honoraria for lectures, as well as advisory board participation compensation, consulting fees, and travel grants from Abbvie, Roche, Boehringer, Bristol-Myers Squibb, Medac, Mundipharma, or UCB; F. Rosenow has received support in the form of personal fees and non-financial support from UCB Pharma; personal fees from Angelini Pharma, Desitin Pharma, Eisai GMBH, Jazz Pharma, LMU Munich, Medilearn India, and Roche Pharma; and research grants from the German Research Foundation (DFG), BMBF—ERAPerMed Programme, European Union (FP7), Hessisches Ministerium für Wissenschaft und Kunst (LOEWE-Programme), Hessisches Ministerium für Soziales und Integration Detlev-Wrobel-Fonds for Epilepsy Research Frankfurt, Reiss-Stiftung, Dr. Senckenbergische-Stiftung, Ernst Max von Grunelius-Stiftung, Chaja Foundation, Dr. Schär Deutschland GmbH, Vitaflo Deutschland GmbH, Nutricia Milupa GmbH, and Desitin Pharma, outside of the submitted work; FR reports that he is part of the editorial board of Neurological Research and Practice. L. Kämppi has received support in the form of speaker honoraria from UCB and Merck and Eisai, congress/travel support from UCB and Angelini Pharma, and personal grants from the Michael Foundation, Finnish Neurology Association, and HUS Neurocenter; A. Strzelczyk has received support from Angelini Pharma, Biocodex, Desitin Arzneimittel, Eisai, Jazz (GW) Pharmaceuticals, Marinus Pharma, Precisis, Takeda, UCB (Zogenix) Pharma, and UNEEG Medical in the form of personal fees and grants. AS reports that he is part of the editorial board of Neurological Research and Practice. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Functional status of all patients measured by modified Rankin Scale before and after SE (A) stratified by tumor progression signs (B), tumor category (C), and SE refractoriness (D)
Fig. 2
Fig. 2
Long-term outcomes depicted by Kaplan-Maier curves stratified by tumor category (A, B), tumor progression signs (C), and SE refractoriness (D)
See this image and copyright information in PMC

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